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Cold injuries during the pilgrimage

Injuries caused by the cold

Pilgrims on the Way of Saint James in the winter months should bear in mind that the temperature can play against them. The Pilgrim’s Way crosses several mountainous areas, and to provide protection, the best thing to do is protect your fingers, toes, ears, and nose from the cold.

It is advisable to wear wool, feather, or synthetic fibre clothing, even in the harshest conditions. Keeping the head warm is essential, as a large amount of heat is lost through the head. Besides, eating and drinking enough, without excess, is the third factor to consider protecting yourself from the cold.

In case of prolonged exposure to a very low temperature, the pilgrim risks that the blood vessels in these parts of the body will constrict. It is an automatic mechanism by which the body ensures that it sends blood to vital organs such as the heart and brain. However, this self-protection comes at a price: all the body’s outermost areas cool down more quickly. That can cause some injuries to the body, sometimes resulting in irreparable damage.

Hypothermia

Hypothermia occurs when you have an abnormally low body temperature. That can occur due to a loss of heat faster than the time it takes to burn energy to replenish it. The elderly and children are most prone to hypothermia, although no one is immune from hypothermia.

Causes

One way in which heat is lost is by convection through cold or wind. Another is heat loss by conduction, through sitting for a long time on a frozen surface, being dressed in wet clothes or being immersed in freezing water.

Symptoms

Hypothermia occurs gradually and subtly without the person being aware of it. Movement becomes slow, clumsy and reaction time is slower. Also, the mind becomes cloudy, the person does not think clearly and hallucinates.

A person suffering from hypothermia may fall, walk aimlessly, or lie down to rest and perhaps die. If the person is in water, maybe he is moving with difficulty or gives up and eventually dies from drowning.

Treatment

In case the pilgrim suffers from hypothermia, the first step is to put dry clothes on the patient and give him warm drinks to drink. If they are in a hostel, they can take a shower with lukewarm water and gradually increase their temperature.

If the person is unconscious, wrap them in warm clothes and transfer them urgently and directly to a hospital. Ideally, try to call the emergency services for professional transport. However, if the person is in a place too inaccessible for an ambulance to reach or if you are warned that it may take too long to arrive, the patient should be moved very carefully so as not to cause an irregular heart rhythm (arrhythmia), which could be fatal.

Partial frostbite

A cold injury in which parts of the skin are frozen but not irreversibly damaged. The frozen areas of skin become white and hard, then swell and become painful. The skin may then peel off, as happens after sunburn. These affected surfaces may remain sensitive to the cold for months or years. If frostbite is mild, it is enough to warm the area. If it is severe, the same treatment as for frostbite should be used.

Frostbite

Frostbite injury is caused by a decrease in blood flow and the formation of ice crystals in the tissues. As a result, one or more parts of the body are permanently damaged. The frostbitten skin becomes reddish, the limb becomes swollen and painful until it finally turns black, which means it becomes necrotic because the cells in the frostbitten areas die. Depending on the degree of frostbite, the tissue may recover or become gangrenous.

People with poor circulation due to arteriosclerosis (thickening and hardening of the artery walls), smoking or some neurological disorders are more prone to frostbite. Frostbite can also occur due to a physical effect. This is the case for people wearing tight gloves or boots.

Treatment

The patient should be wrapped in one or more blankets. A feather bag may also be useful. If it is only a frostbitten limb, the patient should be immersed in warm water, no more than 40 degrees Celsius.

The victim should not be rubbed with snow, nor should he/she sit in front of a fire or a heat source of excessive heat. As a first treatment, the victim should be given hot drinks. The damaged area should be carefully washed, dried well, wrapped in sterile gauze, and bandaged without compression to avoid infection.

As soon as possible, the patient should be taken to a hospital for assessment and appropriate treatment. One possibility is surgery to clean out the dead tissue, and sometimes the limb needs to be amputated. At best, recovery is slow over several months. The pilgrim may pretend to walk on frozen feet until they reach safety. However, once the feet warm up, the pain can be unbearable. Wandering can cause irreversible damage.

Chilblains

Chilblains are painful cold or burning sensations on parts of the body that have been frozen. They are caused by exposure to cold, even if it is not very intense. They are hard to treat and persist for years.

Immersion foot

An immersion foot is an injury caused by the action of cold when a foot remains in a wet sock or boots for days. The foot becomes pale, damp and cold, and circulation is weakened. It can lead to infection.

In case of infection, antibiotics should be given, and the person should receive the tetanus vaccine or a “booster” vaccination if he has already vaccinated. Treatment consists of drying, cleaning, and gently warming the foot. The limb should be kept in an elevated position. This process rarely occurs in the hands.

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